Doctors, not lawyers, should treat mental illness
By Amy Ridenour
web posted August 4, 2003
The nation's top psychiatrists are struggling with a daunting
dilemma these days.
At issue: allegations that new drugs proving effective for
schizophrenia might contribute to the risk of diabetes and the
desire of some lawyers to sue "deep-pockets" drug
manufacturers without waiting until the facts are known.
The issue is being watched closely by personal injury lawyers
fresh from the asbestos and tobacco wars and looking for their
next lucrative lawsuit.
Schizophrenia is a severe, often dangerously debilitating mental
illness, probably the most difficult mental illness for sufferers and
their families. Symptoms include hallucinations, delusions,
disordered thinking and unusual behavior. Victims of the disease
find it difficult to have careers and relationships, and often suffer
acute social stigma.
The drugs at issue -- atypical anti-psychotics such as Eli Lilly's
Zyprexa and Janssen's Risperdal -- have been proven in many
cases to be a more effective treatment than older drugs, with
more favorable outcomes and fewer side effects.
But the benefits of the drugs have been obscured as personal
injury lawyers seeking clients have begun buying newspaper ads
and establishing websites that strongly suggest the new drugs are
linked to increased incidences of diabetes.
When vulnerable schizophrenia patients learn of the lawyer-
generated controversy, they may stop taking their medication,
causing harm to themselves and possibly to others. Failure to
take medications properly already is a huge barrier to
schizophrenia treatment, and news about lawsuits only
exacerbates the situation.
Of course, science is not conclusive; the link between depression
and diabetes is nebulous at best. Long before the advent of anti-
psychotic drugs, studies have found that people with
schizophrenia are two to four times more likely to develop
diabetes than the general population. What isn't known is why.
Can schizophrenia itself somehow be causing diabetes -- which
is believed to be one of the most undiagnosed diseases today?
Are changing lifestyle factors involved? Could genetic
predispositions be the trigger? Or, as a few inconclusive studies
now speculate, is the diabetes link related to medications?
These are tough questions that ought to be settled by scientists
and doctors rather than lawyers in search of sympathetic juries
and big checks.
Schizophrenia patients are already among the most difficult
patients to treat. Many struggle simply to survive, sometimes
living on the margins of society or mired in homelessness.
The public debate so far has been dominated by inadequate
science. None of the reports linking the drugs to diabetes stem
from the gold standard of clinical science: double-blind,
randomized, long-term research trials in large populations.
And, it's not entirely clear whether patients who take the drugs
and test positive for diabetes actually had diabetes before they
ever began taking the medication. Still, the results made
headlines.
Psychiatry isn't about leather couches and pipe-smoking. Today,
the top doctors in the mental health profession must call on a
host of divergent skills to tackle confounding issues that involve
politics, ethics, economics and the law as much as medicine
itself.
Psychiatry is far more nuanced than lawsuits can lead you to
believe. While lawyers might claim that an effective treatment
should instantly be tossed aside because of possible side effects,
doctors seek to tailor the best solution for individual patients
from competing alternatives.
And, in the process, they struggle to sort through all the studies -
from the inconclusive ones that show the drugs might be linked to
diabetes to a recent study that suggests the drugs may actually
have a protective effect against diabetes.
While we wait for science to speak definitively about the
diabetes link, a partial solution to the current dilemma is to make
routine screening for diabetes a part of what's called "standard of
care" for schizophrenia. That means it would be an automatic
part of the diagnosis and treatment regimen provided to all
schizophrenia patients.
Another solution is a partnership between the medical
establishment and the Food and Drug Administration to produce
definitive, top-notch research to resolve where the diabetes link
truly lies.
Other measures are right-before-your-eyes easy, such as
providing warning labels with the medications. Patients, of
course, read. Including patients in the framework of solutions is
deceptively simple -- and effective.
It is crucial that we keep these two terrible diseases in their
proper perspective. Though it affects fewer people than
diabetes, schizophrenia is a grave illness that can engulf the entire
lives of not just patients, but family members and loved ones. It
must be treated as effectively as possible.
Rushing to court in the absence of solid science solves nothing,
yet may hurt many.
Amy Ridenour is president of the National Center for Public
Policy Research. Contact the author at
legalbriefs@nationalcenter.org.
Enter Stage Right -- http://www.enterstageright.com